Evaluating a Water Quality Assurance Fund Intervention in Ghana and Kenya

The objective of this study is to evaluate the effects of a novel financial and capacity strengthening intervention (the 'Water Quality Assurance Fund' program) on water safety management in rural Ghana and Kenya. The investigators hypothesize the intervention will improve water system operator knowledge, chlorination practices, and water quality at the point of collection, as well as improve consumer satisfaction, awareness, and willingness-to-pay for water that is tested and treated.

Study Overview

• Status: Recruiting
• Conditions: Satisfaction; Knowledge; Water Quality; Water Treatment
• Intervention / Treatment: Other: Water Quality Assurance Fund

Detailed Description

Regular water quality monitoring by water suppliers is essential for maintaining adequate treatment processes and verifying safe water quality to protect public health. Yet, many small water suppliers are unable to conduct regular water quality tests due to financial, logistical, and capacity constraints. The goals of the Water Quality Assurance Fund program are to address these constraints by incentivizing established laboratories to extend their services to these smaller water systems and, in parallel, promote the use of water quality data for better water safety management.

The objective of this study is to evaluate the effects of a novel financial and capacity strengthening intervention (the 'Water Quality Assurance Fund' program) on water safety management in rural Ghana and Kenya. As part of the intervention, written legal agreements between water systems, centralized laboratories, and the organization facilitating the Assurance Fund will provide water systems with regular water quality testing and provide laboratories a guarantee of payments if water systems fail to pay for testing services on time. The Assurance Fund program will also deliver capacity strengthening, technical guidance, and community sensitization activities.

The investigators hypothesize the intervention will improve water system operator knowledge, chlorination practices, and water quality at the point of collection, as well as improve consumer satisfaction, awareness, and willingness-to-pay for water that is tested and treated. A secondary aim is to assess implementation challenges and enabling factors associated with the expansion of water testing services by existing professional water quality laboratories to rural water suppliers.

• Study Type: Interventional
• Enrollment (Estimated): 4800
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Valerie Bauza, PhD; Phone Number: 4148011025; Email: valerie@aquaya.org
• Study Contact Backup: Name: Caroline Delaire, PhD; Email: caroline@aquaya.org

Study Locations

• Ghana
  • Accra, Ghana
    • Recruiting
    • The Aquaya Institute
    • Contact: Bashiru Yachori; Phone Number: 233246884576; Email: bashiru@aquaya.org
• Kenya
  • Nairobi, Kenya
    • Recruiting
    • The Aquaya Institute
    • Contact: Peace Musonge; Phone Number: 32489116884; Email: peace@aquaya.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Eligibility to receive the intervention was determined by water system criteria:

Inclusion Criteria:

• The district or county government was interested in participating in the Assurance Fund program and water systems within the district/county were accessible to a partner central laboratory that was able to provide water sample collection and testing services for a fee.
• Water systems were functional.
• Water systems were piped water systems (Kenya, Ghana) or mechanized boreholes with a single tapstand (Ghana).
• Water systems could afford regular water quality testing from the selected laboratory.

Exclusion Criteria:

• Water systems did not meet above inclusion criteria.

To be eligible to participate in household surveys, participants need to be at least 18 years of age and a customer of a eligible water system.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Assurance Fund Intervention Arm 1; In this study arm, intervention activities will start after initial baseline data collection.	Other: Water Quality Assurance Fund; At the water system level: Written legal agreements between water systems, centralized laboratories, and the organization facilitating the Assurance Fund will provide water systems with regular water quality testing and provide laboratories a guarantee of payments if water systems fail to pay for testing services on time (for up to three concurrent unpaid invoices). Regular debrief meetings will be held with water operators and local government authorities to discuss test results and water treatment options, and to encourage water systems to share water quality information with their consumers. Technical guidance to improve water treatment will be provided, if requested by water system operators or local government authorities.; At the community level: Community engagement, primarily at the onset, to inform the community about the water quality testing program and answer questions.
Experimental: Assurance Fund Intervention Arm 2; The intervention activities are the same as those described in Arm 1. However, in this study arm, the intervention activities will start 6 months later than those in Arm 1. This arm will serve as a controlled comparison during those initial 6 months.	Other: Water Quality Assurance Fund; At the water system level: Written legal agreements between water systems, centralized laboratories, and the organization facilitating the Assurance Fund will provide water systems with regular water quality testing and provide laboratories a guarantee of payments if water systems fail to pay for testing services on time (for up to three concurrent unpaid invoices). Regular debrief meetings will be held with water operators and local government authorities to discuss test results and water treatment options, and to encourage water systems to share water quality information with their consumers. Technical guidance to improve water treatment will be provided, if requested by water system operators or local government authorities.; At the community level: Community engagement, primarily at the onset, to inform the community about the water quality testing program and answer questions.
Experimental: Assurance Fund Intervention Arm 3; The intervention activities are the same as those described in Arm 1. However, in this study arm, the intervention activities will start 12 months later than those in Arm 1. This arm will serve as a controlled comparison during those initial 12 months.	Other: Water Quality Assurance Fund; At the water system level: Written legal agreements between water systems, centralized laboratories, and the organization facilitating the Assurance Fund will provide water systems with regular water quality testing and provide laboratories a guarantee of payments if water systems fail to pay for testing services on time (for up to three concurrent unpaid invoices). Regular debrief meetings will be held with water operators and local government authorities to discuss test results and water treatment options, and to encourage water systems to share water quality information with their consumers. Technical guidance to improve water treatment will be provided, if requested by water system operators or local government authorities.; At the community level: Community engagement, primarily at the onset, to inform the community about the water quality testing program and answer questions.
Experimental: Non-randomized Arm; In Ghana only, there is a fourth study arm that will receive the intervention one month prior to Arm 1. This group was non-randomly selected and will primarily serve to support qualitative lessons learned from the Assurance Fund program.	Other: Water Quality Assurance Fund; At the water system level: Written legal agreements between water systems, centralized laboratories, and the organization facilitating the Assurance Fund will provide water systems with regular water quality testing and provide laboratories a guarantee of payments if water systems fail to pay for testing services on time (for up to three concurrent unpaid invoices). Regular debrief meetings will be held with water operators and local government authorities to discuss test results and water treatment options, and to encourage water systems to share water quality information with their consumers. Technical guidance to improve water treatment will be provided, if requested by water system operators or local government authorities.; At the community level: Community engagement, primarily at the onset, to inform the community about the water quality testing program and answer questions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adequate free chlorine residual in water at the point of collection	Free chlorine residual in water at the point of collection above targeted levels of 0.2 mg/L.	Baseline, 6-months, 12-months, 18-months, 24-months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Detectable free chlorine residual in water at the point of collection	Free chlorine residual in water at the point of collection above detectable levels of 0.1 mg/L.	Baseline, 6-months, 12-months, 18-months, 24-months
E. coli in water at the point of collection	E. coli in water at point of collection (binary and categorical).	Baseline, 6-months, 12-months, 18-months, 24-months
Water system operator knowledge	Water system operator knowledge related to water quality (score out of 32 points on a knowledge assessment).	Baseline, 12-months, 24-months
Consumer awareness	Household respondent is aware enrolled water is tested or treated	Baseline, 12-months, 24-months
Consumer satisfaction	Household respondent is satisfied with water supplier. They will be considered satisfied if they report they are either very satisfied or somewhat satisfied with the water supplier. They will be considered dissatisfied if they report they are either very dissatisfied or somewhat dissatisfied with the water supplier.	Baseline, 12-months, 24-months
Willingness-to-pay	Stated willingness-to-pay for treated and tested water for standpipe and private tap users (% increase and absolute increase in local currency).	Baseline, 12-months, 24-months
Adequate free chlorine residual in household stored water	Free chlorine residual in household stored water above targeted levels of 0.2 mg/L.	Baseline, 12-months, 24-months
Detectable free chlorine residual in household stored water	Free chlorine residual in household stored water above detectable levels of 0.1 mg/L.	Baseline, 12-months, 24-months
E. coli in household stored water	E. coli in household stored water (binary and categorical).	Baseline, 12-months, 24-months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Water system chlorination frequency	Water system operator reports weekly chlorinating frequency.	Baseline, 6-months, 12-months, 18-months, 24-months
Water system revenue	Revenue reported by water systems.	Baseline, 6-months, 12-months, 18-months, 24-months
Households use of enrolled water for drinking	Households use of enrolled water for drinking (binary).	Baseline, 12-months, 24-months

Collaborators and Investigators

• Sponsor: The Aquaya Institute
• Collaborators: United States Agency for International Development (USAID); The Leona M. and Harry B. Helmsley Charitable Trust; Conrad N. Hilton Foundation; Kwame Nkrumah University of Science and Technology (KNUST); Water Mission
• Investigators: Principal Investigator: Valerie Bauza, PhD, The Aquaya Institute

Study record dates

Study Major Dates

• Study Start (Actual): December 6, 2022
• Primary Completion (Estimated): September 30, 2025
• Study Completion (Estimated): September 30, 2025

Study Registration Dates

• First Submitted: August 20, 2024
• First Submitted That Met QC Criteria: August 22, 2024
• First Posted (Actual): August 26, 2024

Study Record Updates

• Last Update Posted (Actual): August 26, 2024
• Last Update Submitted That Met QC Criteria: August 22, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: REAL-Water Assurance Fund

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data will be made available.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No